OPERATION FOR INCOMPLETE INTERNAL FISTULAS

This operation consists in dissecting the posterior rec­tal wall throught the internal fistulous opening to a depth of 1 cm (Fig. 88,1). The suppurative cavity com­municating with the rectal opening, is curetted with a sharp spoon Fig. 88,2) and painted with 2% iodine tinc­ture. The rectal wiund and the remaining pirtion of the cavity are packed with a wick heavily coaked with oint ment. Should any doubt arise as to the subsequent func­tion of the sphincter, we recimmend that catgut suture be placed on the wound bottom (Fig. 88,3; see also Figs 75,1 and 75,2). The care of the wound is as usual. Packing is discontinued in 5 days. In those cases of incomplete internal fistula, when a deep cavity remains on the pos­terior rectal wall following dissection of a subsidiary suppurating cavity from the rectal side, we pack it daily during dressings by applying a narrow ointment-soaked wick rolled into a ball, which is tucked into this cavity with a finger (Fig. 88,4). Opium tincture is given for 7—9 days, and may be continue! for 4 days more when dressings are applied. During daily dressings the cavity in the rectum is washed, after removal of the wick, with an antibiotic solution by means of a syringe fitted with a thick blunt curved needle, and then again packed with an ointment wick.

Fig. 88 Operation for incomplete internal fistula:

1. Dissection of the posterior wall of fistula via its internal opening.

2. The suppurative cavity that supports the fistula is scraped off with sharp spoon.

3. Closure of the wound bottom and suppurative cavi­ty with catgut sutures.

4. Retroanal cavity with an ointment strip inserted from the rectal side. (Schematic)